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RC-15-821 (3) V t It Miami Shores Village P�IEcIEIVED Building Department A R ®, 2o�s 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 0-t ` BUILDING Master Permit No.zau 5- RD4 PERMIT APPLICATION Sub Permit No. 1�.`.-U C - ew ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /0&,/o ti45 .2 "4 Pc QQ City: Miami Shores County: Miami Dade Zio: J3 O Folio/Parcel#: I l —'LZ31- u13-OS110 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): S9-Q IW,S SU(I L-L. L Phone#: RG(O(--O( S �Z Address: 2.10 � l -2� f 2vf�1 h rls") C.rCAk fl 0-111 City: \Cn ``9�J�aJ�_ State: Zip: 3 > 09 Tenant/Lessee Name: Phone#: -?.Co(6(D1'C>407-7 X Email: bzm(M-k�h ti• Ckl YY1 CONTRACTOR:Company Name: Phone#: .30S-0?_-_3Li Address: City: -State: Trp: f el!v Qualifier Name: &OA4 't Phone#• (�� ! State Certification or Registration#: C�tI�G l7 oZ. 7�'e� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 2 01C> Square/Linear Footage of Work: Type of work: ❑ Addition 0 Alteration ❑ New t F-1 Repair/Replace ❑ Demolition W—of Work: r-l'l 0 C(A �G V2 d04:e Specify color of color thru We: Submittal Fee$ Permit Fee$ 9 S (J� CCF$ CO/CC$ Scanning Fee$ --75 Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �t (RevbedO2/24/2014) i Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in goat faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection will be charged. t Signature Signature L/� §fiE!!q NMC=-- OWNER or AGENT CONfRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument wa acknowledged before me this day of AOa 611 20_11e, by da of ! .20 �.� .by who is personally known to Bl2 �/1"079. .who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC _-- -- .--- NOTARY PUBLIC: Sign:..,- Sign: Print: •lam Print• .� ►�,, I oil a E .� r a ca Seal: Notary Public-:#EE of Florida Seal: =ec COMMISSION # FFIM70 My Comm.Expit 30,2016 EXPIRES:November 20,2018 Commission 847983 � ��*"anoaawww.AARONNOTARY.COM ssrssss •ssssssrsssssssss*ss**ss*****ssasss*s***ss*ssas•sss•sssss:asses APPROVED BY ° Plans Examiner Zoning Structural Review Clerk (ReAsed02/24/2014) .4c Rc� CERTIFICATE OF LIABILITY INSURANCE DATE 5104/16 1() PRODUCER Florida Bankers Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 7278 SW 8 Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXPEND OR Miami,FL 33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)266-6493 Fax (305)262-0879 INSURERS AFFORDING COVERAGE MAIC# INSURED CAPOTE PLUMBING CORP. INSURERA: ACCIDENT INSURANCE COMPANY INSURER S. 6811 SW 7 Street INSURER C: MIAMI,FL 33144 INSURER D: (305)266-3618 INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTMITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MOTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR ADM TYPE OF INSURANCE POLICY NUMBER pA TE( TIVE pPATE Y D�IUAY)N LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000.00 ®COMMERCIAL GENERAL LIABILITY15— CPP 0012250-02 02/19/16 02/19/17 PDREMISESO RENTE.N,rence 100,000.00 ❑❑ CLAIMS MADE © OCCUR MED EXP(Arty one person) 5,000.00 A ❑ ❑ PERSONAL&ADV INJURY 1,000,000.00 ❑ GENERAL AGGREGATE 1,000,000.00 GEWL AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG 1,000,000.00 ® POLICY ❑PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO aocideni) ❑ ALL OMINED AUTOS BODILY INJURY ❑ ❑ SCHEDULED AUTOS (Per person) ❑ HIRED AUTOS BODILY INJURY ❑ NON OWNED AUTOS (Per eeddeno ❑ PROPERTY DAMAGE (Per ac cidenfl GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGG EXCESSIUMBREl.LA LIABILITY EACH OCCURRENCE ❑ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND ❑ WC STATU- ❑ TH- EM PLOYERW'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE I yes,deem be under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT i SPECIAL PROVISIONS L#CFC1427737 CAPOTE PLUMBING CORP. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAUL CITY OF MIAMI SHORES 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO BUILDING&ZONING THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY 10050 NE 2 AVE OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. MIAMI SHORES, FL.33138 AUTHORIZED REPRESENTATIVE ACORD 25(2W1AXq OF O ACORD CORPORAMON 11988